J Korean Med Assoc.  2013 Jul;56(7):592-599. 10.5124/jkma.2013.56.7.592.

Anemia and nutrition in end stage renal disease patient

• Oak CY
• Kim NH

• KMID: 2193049
• DOI: http://doi.org/10.5124/jkma.2013.56.7.592

Abstract

Anemia and malnutrition are common complications of end-stage renal disease. They increase the morbidity and mortality of end-stage renal disease patients and affect their quality of life. However, the mechanisms of anemia and malnutrition are already known, and their therapeutic guidelines are being established. Appropriate iron supplementation and the development of erythropoiesis-stimulating agents have made anemia easier to manage than in the past. In addition, adequate protein and calorie intake have allowed end-stage renal disease patients to maintain a neutral or positive nitrogen balance. These therapeutic approaches have decreased the morbidity and mortality of these end-stage renal disease patients. This review is a summary of the treatment of anemia and nutrition in end-stage renal disease, based on the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline on anemia and other anemia guidelines, and also on the KDOQI guideline on nutrition and European Best Practice Guideline (EBPG) on nutrition.

Keyword

Anemia; Nutrition; Hematinics; Protein-energy malnutrition

MeSH Terms

Anemia
Hematinics
Humans
Iron
Kidney Diseases
Kidney Failure, Chronic
Malnutrition
Nitrogen
Practice Guidelines as Topic
Protein-Energy Malnutrition
Quality of Life
Hematinics
Iron
Nitrogen

Reference

1. Pisoni RL, Bragg-Gresham JL, Young EW, Akizawa T, Asano Y, Locatelli F, Bommer J, Cruz JM, Kerr PG, Mendelssohn DC, Held PJ, Port FK. Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004; 44:94–111.

2. Caro J, Brown S, Miller O, Murray T, Erslev AJ. Erythropoietin levels in uremic nephric and anephric patients. J Lab Clin Med. 1979; 93:449–458.

3. Marckmann P. Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol. 1988; 29:75–78.

4. KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007; 50:471–530.

5. Tsubakihara Y, Nishi S, Akiba T, Hirakata H, Iseki K, Kubota M, Kuriyama S, Komatsu Y, Suzuki M, Nakai S, Hattori M, Babazono T, Hiramatsu M, Yamamoto H, Bessho M, Akizawa T. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial. 2010; 14:240–275.

6. White CT, Barrett BJ, Madore F, Moist LM, Klarenbach SW, Foley RN, Culleton BF, Tonelli M, Manns BJ. Canadian Society of Nephrology. Clinical practice guidelines for evaluation of anemia. Kidney Int Suppl. 2008; (110):S4–S6.

7. National Clinical Guideline Centre (UK). Anaemia management in chronic kidney disease: rapid update 2011. London: Royal College of Physicians;2011.

8. K/DOQI, National Kidney Foundation. Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2000; 35:6 Suppl 2. S1–S140.

9. Fouque D, Vennegoor M, ter Wee P, Wanner C, Basci A, Canaud B, Haage P, Konner K, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Tordoir J, Vanholder R. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007; 22:Suppl 2. ii45–ii87.

10. Movilli E, Pertica N, Camerini C, Cancarini GC, Brunori G, Scolari F, Maiorca R. Predialysis versus postdialysis hematocrit evaluation during erythropoietin therapy. Am J Kidney Dis. 2002; 39:850–853.

11. Roger SD, McMahon LP, Clarkson A, Disney A, Harris D, Hawley C, Healy H, Kerr P, Lynn K, Parnham A, Pascoe R, Voss D, Walker R, Levin A. Effects of early and late intervention with epoetin alpha on left ventricular mass among patients with chronic kidney disease (stage 3 or 4): results of a randomized clinical trial. J Am Soc Nephrol. 2004; 15:148–156.

12. Besarab A, Amin N, Ahsan M, Vogel SE, Zazuwa G, Frinak S, Zazra JJ, Anandan JV, Gupta A. Optimization of epoetin therapy with intravenous iron therapy in hemodialysis patients. J Am Soc Nephrol. 2000; 11:530–538.

13. DeVita MV, Frumkin D, Mittal S, Kamran A, Fishbane S, Michelis MF. Targeting higher ferritin concentrations with intravenous iron dextran lowers erythropoietin requirement in hemodialysis patients. Clin Nephrol. 2003; 60:335–340.

14. Van Wyck DB, Roppolo M, Martinez CO, Mazey RM, McMurray S. United States Iron Sucrose (Venofer) Clinical Trials Group. A randomized, controlled trial comparing IV iron sucrose to oral iron in anemic patients with nondialysis-dependent CKD. Kidney Int. 2005; 68:2846–2856.

15. Fishbane S, Frei GL, Maesaka J. Reduction in recombinant human erythropoietin doses by the use of chronic intravenous iron supplementation. Am J Kidney Dis. 1995; 26:41–46.

16. Jin DC. Current status of dialysis therapy in Korea. Korean J Intern Med. 2011; 26:123–131.

17. Bolasco P, Atzeni A. Erythropoiesis-stimulating agents: switch from intravenous to subcutaneous administration in hemodialyzed patients. Int J Clin Pharmacol Ther. 2011; 49:744–749.

18. Faller B, Slingeneyer A, Waller M, Michel C, Grutzmacher P, Muller HP, Barany P, Grabensee B, Issad B, Schmitt H. Daily subcutaneous administration of recombinant human erythropoietin (rhEPO) in peritoneal dialysis patients: a European dose-response study. Clin Nephrol. 1993; 40:168–175.

19. Topf JM. CERA: third-generation erythropoiesis-stimulating agent. Expert Opin Pharmacother. 2008; 9:839–849.

20. Matuszkiewicz-Rowinska J. New European best practice guidelines for the management of anemia in patients with chronic renal failure. Pol Arch Med Wewn. 2005; 113:387–394.

21. Eschbach JW, Abdulhadi MH, Browne JK, Delano BG, Downing MR, Egrie JC, Evans RW, Friedman EA, Graber SE, Haley NR. Recombinant human erythropoietin in anemic patients with end-stage renal disease: results of a phase III multicenter clinical trial. Ann Intern Med. 1989; 111:992–1000.

22. Mitch WE. Malnutrition: a frequent misdiagnosis for hemodialysis patients. J Clin Invest. 2002; 110:437–439.

23. Mitch WE, Goldberg AL. Mechanisms of muscle wasting: the role of the ubiquitin-proteasome pathway. N Engl J Med. 1996; 335:1897–1905.

24. Stenvinkel P, Ketteler M, Johnson RJ, Lindholm B, Pecoits-Filho R, Riella M, Heimburger O, Cederholm T, Girndt M. IL-10, IL-6, and TNF-alpha: central factors in the altered cytokine network of uremia--the good, the bad, and the ugly. Kidney Int. 2005; 67:1216–1233.

25. Garber AJ. Effects of parathyroid hormone on skeletal muscle protein and amino acid metabolism in the rat. J Clin Invest. 1983; 71:1806–1821.

26. Cheung W, Yu PX, Little BM, Cone RD, Marks DL, Mak RH. Role of leptin and melanocortin signaling in uremia-associated cachexia. J Clin Invest. 2005; 115:1659–1665.

27. Pifer TB, McCullough KP, Port FK, Goodkin DA, Maroni BJ, Held PJ, Young EW. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int. 2002; 62:2238–2245.

28. Kopple JD, Zhu X, Lew NL, Lowrie EG. Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int. 1999; 56:1136–1148.

29. Oe B, de Fijter CW, Oe PL, Stevens P, de Vries PM. Four-site skinfold anthropometry (FSA) versus body impedance analysis (BIA) in assessing nutritional status of patients on maintenance hemodialysis: which method is to be preferred in routine patient care? Clin Nephrol. 1998; 49:180–185.

30. Kamimura MA, Josre Dos Santos NS, Avesani CM, Fernandes Canziani ME, Draibe SA, Cuppari L. Comparison of three methods for the determination of body fat in patients on long-term hemodialysis therapy. J Am Diet Assoc. 2003; 103:195–199.

31. Shinaberger CS, Kilpatrick RD, Regidor DL, McAllister CJ, Greenland S, Kopple JD, Kalantar-Zadeh K. Longitudinal associations between dietary protein intake and survival in hemodialysis patients. Am J Kidney Dis. 2006; 48:37–49.

32. Beddhu S, Kaysen GA, Yan G, Sarnak M, Agodoa L, Ornt D, Cheung AK. HEMO Study Group. Association of serum albumin and atherosclerosis in chronic hemodialysis patients. Am J Kidney Dis. 2002; 40:721–727.

33. Chertow GM, Ackert K, Lew NL, Lazarus JM, Lowrie EG. Prealbumin is as important as albumin in the nutritional assessment of hemodialysis patients. Kidney Int. 2000; 58:2512–2517.

34. Aparicio M, Cano N, Chauveau P, Azar R, Canaud B, Flory A, Laville M, Leverve X. Nutritional status of haemodialysis patients: a French national cooperative study. French Study Group for Nutrition in Dialysis. Nephrol Dial Transplant. 1999; 14:1679–1686.

35. Cianciaruso B, Brunori G, Kopple JD, Traverso G, Panarello G, Enia G, Strippoli P, De Vecchi A, Querques M, Viglino G. Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Kidney Dis. 1995; 26:475–486.

36. Levey AS, Adler S, Caggiula AW, England BK, Greene T, Hunsicker LG, Kusek JW, Rogers NL, Teschan PE. Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. Am J Kidney Dis. 1996; 27:652–663.

37. Kopple JD, Shinaberger JH, Coburn JW, Sorensen MK, Rubini ME. Optimal dietary protein treatment during chronic hemodialysis. Trans Am Soc Artif Intern Organs. 1969; 15:302–308.

38. Kopple JD, Bernard D, Messana J, Swartz R, Bergstrom J, Lindholm B, Lim V, Brunori G, Leiserowitz M, Bier DM. Treatment of malnourished CAPD patients with an amino acid based dialysate. Kidney Int. 1995; 47:1148–1157.

39. Kopple JD, Monteon FJ, Shaib JK. Effect of energy intake on nitrogen metabolism in nondialyzed patients with chronic renal failure. Kidney Int. 1986; 29:734–742.

40. Ikizler TA, Greene JH, Wingard RL, Parker RA, Hakim RM. Spontaneous dietary protein intake during progression of chronic renal failure. J Am Soc Nephrol. 1995; 6:1386–1391.

41. McCusker FX, Teehan BP, Thorpe KE, Keshaviah PR, Churchill DN. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. How much peritoneal dialysis is required for the maintenance of a good nutritional state? Kidney Int Suppl. 1996; 56:S56–S61.

42. Fissell RB, Bragg-Gresham JL, Gillespie BW, Goodkin DA, Bommer J, Saito A, Akiba T, Port FK, Young EW. International variation in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004; 44:293–299.